WHO Vaccine

Temperature-controlled transport
operations
Technical supplement to
WHO Technical Report Series, No. 961, 2011
Annex 9: Model guidance for the storage and transport of time and
temperaturesensitive pharmaceutical products

January 2014
World Health Organization 2014
WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22
791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications whether for
sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: permissions@who.int).
The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city
or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors
and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this
publication. However, the published material is being distributed without warranty of any kind, either expressed or
implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World
Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views
expressed in this publication.

Acknowledgments
The author of this document is Kevin ODonnell, Exelsius Cold Chain Management
Consultancy and member of the United States Pharmacopeia Expert Committee of
Packaging, Storage and Distribution 2010-2015 cycle. Contributions to the document have
also been made by Jim Bacon, Senior Director, Demand Planning and International
Customer Operations - US Office, Grifols, Inc.

Technical Supplement: Temperature-controlled transport operations

Contents
Acknowledgments ................................................................................................................................ 1
Contents ................................................................................................................................................... 2
Abbreviations ........................................................................................................................................ 3
Glossary ................................................................................................................................................... 4
1.

Introduction .................................................................................................................................. 8
1.1 Requirements ...................................................................................................................................... 8
1.2 Objectives.............................................................................................................................................. 8
1.3 Target readership .............................................................................................................................. 8

2.

Guidance .......................................................................................................................................10
2.1 Associated materials and equipment ...................................................................................... 10
2.2 Available shipping systems ......................................................................................................... 10
2.2.1

Refrigerated vehicles ........................................................................................................................ 10

2.2.2

Temperature-controlled vehicles ................................................................................................ 10

2.2.3

Passive shipping systems................................................................................................................. 11

2.2.4

Active shipping systems for air transport ............................................................................... 12

2.2.5

Active shipping systems for ocean transport......................................................................... 12

2.3 Defining user requirements ........................................................................................................ 13

2.3.1

User Requirements Specification ................................................................................................ 13

2.3.2

Service Level Agreements (SLAs) ................................................................................................ 13

2.4 Identifying and controlling risk ................................................................................................. 14

2.5 Managing refrigerated road shipments.................................................................................. 17
2.6 Managing passive container road shipments ...................................................................... 18
2.7 Introduction to air transport ...................................................................................................... 19
2.7.1

Types of air carrier ............................................................................................................................ 20

2.7.2

Air transport labelling ..................................................................................................................... 21

2.8 Air transport processes................................................................................................................. 22

2.9 Managing air shipments ............................................................................................................... 22
References ............................................................................................................................................26
Annex 1 Packing a refrigerated vehicle ..................................................................................27
Revision history ..................................................................................................................................28

Technical Supplement: Temperature-controlled transport operations

Abbreviations
AWB

Air Way Bill

CI

Chemical Indicator

CRT

Controlled Room Temperature

ETI

Electronic Temperature Integrator

EDLM

Electronic Data Logging Monitor

IATA

International Air Transport Association

NOTOC

Notice to Captain

PDA

Parenteral Drug Association

SLA

Service Level Agreement

SOP

Standard Operating Procedure

TTI

Time-Temperature Integrator

TTSPP

Time- and Temperature-Sensitive Pharmaceutical Product

ULD

Unit Load Device

URS

User Requirements Specification

Technical Supplement: Temperature-controlled transport operations

Glossary
3PL: Third party logistics provider: a firm that provides service to its customers of
outsourced (or "third party") logistics services for part, or all of their supply chain
management functions.
4PL: Fourth party logistics provider: a general contractor who manages other 3PLs,
truckers, forwarders, custom house agents, and others, essentially taking responsibility for
a complete logistics process for the customer.
Active systems: Externally powered or on-board powered systems using electricity or
other fuel source to maintain a temperature-controlled environment inside an insulated
enclosure under thermostatic regulation (e.g. cold rooms, refrigerators, temperaturecontrolled trucks, refrigerated ocean and air containers).
Advanced Phase Change Materials (PCMs): Temperature stabilizing media (sometimes
referred to as refrigerants), chemically engineered so that their latent heat of fusion
occurs at a temperature other than zero C, phasing from one state of matter to another
(i.e. liquid to solid) at a pre-formulated temperature. Such materials are typically
comprised of oils, salts, or paraffin.
Ancillary packaging components: Packaging elements used to protect the TTSPP and
support or enhance performance of the completed package. This may include retainers,
dunnage, secondary protective packaging, and temperature data logging devices.
Chemical indicators: (also called markers or phase-change indicators), are generally
impregnated onto a paperboard substrate. These indicators, sometimes referred to as
critical temperature indicators, are based on a phase change or chemical reaction that
occurs as a function of temperature. Examples include liquid crystals, waxes, polymers,
and lacquers that change phase, and thereby their appearance, as a function of
temperature. Chemical temperature threshold indicators may be reversible or irreversible
and are suitable for high or low temperatures. Temperature threshold indicators show a
response and typically are single-use devices. These indicators provide a signal only when
exposed to temperatures higher than (ascending indicator) or lower than (descending
indicator) a predetermined threshold temperature.
They typically use liquid diffusion technology to signal when a single event timetemperature threshold has been exceeded by irreversibly changing colour, either
instantaneously or with some time delay. The active colloidal substance in freeze
indicators is typically composed of particles of material evenly distributed within a liquid.
At a specific relative temperature the particles in the marker colloid become unstable,
eliminating the repulsive forces that keep the particles separate. The chemicals coagulate,
resulting in a change of colour. The accuracy and precision of these indicators depend to
some extent on human interpretation.
Electronic temperature monitoring and event logger system: A system for recording
and reporting air and/or product temperatures, with optional facilities for recording and
reporting specific events such as door-opening or defrost cycles and for issuing alarms.
Such systems may be user-programmable may also be remotely monitored via a satellite
link.

Technical Supplement: Temperature-controlled transport operations

Electronic Data Integrator (EDI): A hybrid electronic instrument intelligently

programmed like an Electronic Temperature Indicator (ETI) with the report/data
producing capabilities of an Electronic Data Logging Monitor (EDLM) that combines the
features and functions of a Go/No-Go device (like and indicator) with the record retention
and data tracking of an EDLM but with greater granularity and data management
flexibility. It uses pre-programmed temperature threshold intelligence to integrate postanalytic functional steps that are typically performed by trained personnel.
Electronic Temperature Indicator (ETI): A compact, portable device that measures,
temperature over time by means of a built-in sensor. They come in a wide range of forms,
features, configurations, cost and levels of performance. Their composition consists of four
basic components: a thermistor sensor, a microprocessor, a memory chip, and power
source (lithium battery). They provide either a single temperature threshold or multiple
alarm thresholds. These devices are employed for simple accept / reject decision making,
and their time and temperature accuracy is quite precise.
Electronic Data Logging Monitor (EDLM): A small portable device that measures and
stores temperature at a pre-determined time intervals by means of an electronic sensor.
They have programmable alarm capabilities, integrated displays, and can create reports
and graphs which may be permanently stored, shared and analysed via proprietary
hardware, software, desktop application or through hosted databases.
External distribution: Transport of TTSPPs through various steps in the customers
supply chain (i.e. transport from a pharmaceutical manufacturers distribution centre, to
commercial customers (including wholesalers, retailers and buying groups), to clinical
facilities or direct to the patient).
Passive systems: Systems which maintain a temperature-controlled environment inside
an insulated enclosure, with or without thermostatic regulation, using a finite amount of
pre-conditioned coolant in the form of chilled or frozen gel packs, phase change materials,
dry ice or others.
Pharmaceutical product: Any product intended for human use or veterinary product
intended for administration to food producing animals, presented in its finished dosage
form, that is subject to control by pharmaceutical legislation in either the exporting or the
importing state and includes products for which a prescription is required, products
which may be sold to patients without a prescription, biologicals and vaccines. It does not,
however, include medical devices1.
Refrigeration equipment: The term refrigeration or refrigeration equipment means
any equipment whose purpose is to lower air and product temperatures and/or to control
relative humidity.
Refrigerated vehicles: Road transport vehicles such as vans, trucks and semi-trailers
whose isolated thermostatically controlled cargo compartment maintains the temperature
at all times within the labelled range of the product being transported.
Service Level Agreement (SLA): A service level agreement or contract is a negotiated
agreement between the customer and service provider that defines the common
understanding about materials or service quality specifications, responsibilities,
Definition from WHO/QAS/08.252 Rev 1 Sept 2009. Proposal for revision of WHO good distribution
practices for pharmaceutical products Draft for comments.

Technical Supplement: Temperature-controlled transport operations

guarantees and communication mechanisms. It can either be legally binding, or an

information agreement. The SLA may also specify the target and minimum level
performance, operation or other service attributes2.
Shipping container or shipping system: All components constituting a completed
package including: the outer shipping container, all internal ancillary packaging
components and temperature stabilizing medium.
Standard Operating Procedure (SOP): A set of instructions having the force of a
directive, covering those features of operations that lend themselves to a definite or
standardized procedure without loss of effectiveness. Standard operating policies and
procedures can be effective catalysts to drive performance improvement and improve
organizational results.
Storage temperature: The temperature range listed on the TTSPP label, and within the
regulatory filings, for long-term storage.
Temperature-controlled: Includes any environment in which the temperature is actively
or passively controlled at a level different from that of the surrounding environment,
within precise pre-defined limits.
Temperature-controlled vehicles: Road transport vehicles such as vans, trucks and
tractor semi-trailers and vans whose isolated thermostatically controlled cargo
compartment maintains a controlled temperature environment designed to limit exposure
of packed product to excessively high or low temperatures during transport.
Temperature excursion: An event in which a TTSPP is exposed to temperatures outside
the range(s) prescribed for storage and/or transport. Temperature ranges for storage and
transport may be the same or different; they are determined by the product manufacturer,
based on stability data.
Temperature stabilizing medium: Ice or gel packs; gel bricks, bottles or pouches; cool
water or warm water packs, phase change materials, dry ice, rapid evaporation media.
Also referred to as refrigerants or coolants.
Time-Temperature Integrators (TTIs): Are generally chemically impregnated onto a
pulp or paperboard substrate. Their reaction rate or diffusion process is used to estimate a
temperature equivalent integrated over time. Thus, TTIs provide a measure of
accumulated heat rather than instantaneous temperature such as a spike or critical
threshold (see Chemical Indicators). The reactions generally are irreversibleonce a
colour change, colour development, or diffusion process has taken place, exposure to low
temperatures will not restore the indicator to its original state. The accuracy and precision
of these indicators depend to some extent on human interpretation. They change colour,
or are marked by a hue progression in intensity (generally from light to dark) in response
to cumulative changes in temperature, such as heat, at a rate dependent on the Arrhenius
Equation. A TTI accumulates all of the temperature conditions experienced by the product
to which it is affixed. The colour development can be customized based on the known
stability of the product, and in much the same way that most biologics and
pharmaceuticals degrade when exposed to heat - faster at higher temperatures, and
slower at lower temperatures.

Definition from IATA, Chapter 17, 9th Edition, June 2013.

Technical Supplement: Temperature-controlled transport operations

Time and temperature sensitive pharmaceutical product (TTSPP): Any

pharmaceutical good or product which, when not stored or transported within predefined environmental conditions and/or within pre-defined time limits, is degraded to
the extent that it no longer performs as originally intended.
Unit Load Device (ULD): A container used for consolidating and transporting cargo
aboard aircraft. They are generally made of aluminium and / or fibreglass and configured
to fit the geometry of an aircraft and are considered part of the aircraft frame. Large Active
Systems fall into the category of ULD. There are two basic sizes classified by the airline
industry: LD-3 and LD-9.
Validation: Documented testing performed under highly controlled conditions,
demonstrating that processes, methods, and systems consistently produce results meeting
pre-determined acceptance criteria.3
Work instruction: Describes how to complete a specific task. Contrast an SOP which
describes who (title or department) should carry out a series of tasks, and in what
sequence.

3 PDA Technical Report No. 39: Guidance for Temperature Controlled Medicinal Products:
Maintaining the Quality of Temperature-Sensitive Medicinal Products through the Transportation
Environment, 2007.

Technical Supplement: Temperature-controlled transport operations

1.

Introduction

This technical supplement has been written to amplify the recommendations given in
WHO Technical Report Series No. 961, 2011, Annex 9: Model guidance for the storage and
transport of time- and temperature-sensitive pharmaceutical products4, section 6.4 and 6.5.
It provides guidance on how to condition, load and handle equipment used to transport
TTSPPs in order to maintain these products with a pre-defined operating temperature
range. The supplement covers refrigerated and temperature-controlled transport vehicles
and active and passive shipping containers. Fixed storage systems, such as cold rooms and
refrigerators, are outside the scope of this document.
The following Technical Supplements are also relevant:

Qualification of shipping containers.

Qualification of temperature-controlled road vehicles.

Temperature and humidity monitoring systems for transport operations.

Transport route profiling qualification.

1.1

Requirements

Packaging systems should be validated before use. Generally speaking, the shipper is
responsible for ensuring product temperature compliance during transport.

1.2

Objectives

The objective of the Technical Supplement is to:

Provide a general technical introduction to the active and passive packaging and
transport systems used for distributing TTSPPs.

Describe how to pack temperature controlled products correctly in active and

passive systems and how to manage their transit through the transport
environment.

Describe the correct use of the various types of temperature and humidity
monitoring device.

Describe the documentary evidence that should be supplied to regulatory

authorities and other interested parties so that quality assurance and regulatory
compliance can be demonstrated and maintained.

1.3

Target readership

This technical supplement is intended for all those responsible for the transport of TTSPPs
through the supply chain from one fixed storage point to another.
Staff responsible for transport operations need to understand the importance of
pharmaceutical product temperature stability, have a sound working knowledge of
applicable logistics and transport methodologies within their organizations, and they
should understand the basic concepts of packaging thermodynamics and good
documentation practice. They should have a good knowledge of the various types of
4

http://apps.who.int/medicinedocs/documents/s18683en/s18683en.pdf

Technical Supplement: Temperature-controlled transport operations

temperature monitoring device used in the transport environment, together with their
strengths, weaknesses and appropriate uses. They must also be able to train and supervise
junior staff so that they are able to carry out the tasks described below in a reliable and
consistent manner.

Technical Supplement: Temperature-controlled transport operations

2.

Guidance

This section describes the processes that need to be followed to ensure safe transport of
TTSPPs by road and air. The options available for ocean transport are briefly covered. For
general guidance on importation and port clearance procedures readers should also refer
to Chapter 24 of MDS-3: Managing Access to Medicines and other Health Technologies
Importation and port clearing and to the IATA document: Temperature Control
Regulations: The Global Standard for the Safe Transportation of Healthcare Products by Air.

2.1

Associated materials and equipment

The physical components of a quality-assured temperature-controlled transport system

are the active and passive packaging systems, described below, in which products are
placed during transport. Temperature monitoring devices are also a key component. The
specific characteristics and uses of these devices are described in the companion Technical
Supplement: Temperature and humidity monitoring systems for transport operations.

2.2

Available shipping systems

Temperature control during ground air or ocean transport can be maintained using either
active or passive shipping systems, as described below.
2.2.1

Refrigerated vehicles

This category includes vans, rigid trucks and semi-trailers have an insulated
thermostatically controlled cargo compartment which is maintained within the labelled
temperature range of the products being transported by means of a dedicated
refrigeration unit. Vans and small rigid trucks typically have refrigeration units powered
directly by the vehicles engine. Larger rigid vehicles and semi-trailers have independent
diesel-powered refrigeration units. Both types may also have electrical back-up so that
they can be mains-powered whilst parked. All refrigerated vehicles should be equipped
with an on-board electronic temperature monitoring and event logger system.
Refrigerated vehicles must be properly qualified to operate on designated routes. They
should only be used in operating environments that are able to manage the equipment,
and over roads which will not damage the vehicles. Refer to Technical Supplement:
Qualification of temperature-controlled road vehicles.
2.2.2

Temperature-controlled vehicles

These are similar to refrigerated vehicles, except that the vehicle itself simply moderates
the ambient temperature, either by heating or cooling. The transported product is
generally packed in a qualified passive shipping system designed to keep it within the
labelled temperature range. The temperature-controlled environment in the vehicle
serves to extend the autonomy of the passive shipping system and protect the product
from temperature extremes. Care must be taken not to subject the packages to
refrigerated temperatures (e.g. +2C to +8C) for extended periods because this risks
freezing the package contents. Ideally, every effort should also be made to avoid exposure
of active and passive packaging to temperatures below +15C. In order to ensure this,

Technical Supplement: Temperature-controlled transport operations

10

temperature-controlled vehicles should preferably be equipped with an on-board

electronic temperature monitoring and event logger system.
The recommendations on use described above for refrigerated vehicles also apply.
2.2.3

Passive shipping systems

A particular advantage of passive systems in resource-constrained settings is that safe

transport of TTSPPs can reliably be provided over poor roads. They can also be used for
air transport. A properly qualified passive shipping system can be used to maintain
effective temperature control of the drug product at ambient transport temperatures.
However these systems should only be used after the route and container has been
qualified see Technical Supplements: Transport Route Profile Qualification and
Qualification of shipping containers.
Passive shipping systems consist of a combination of insulated material and temperature
stabilizing media. When correctly configured, such a combination can keep the internal
contents of the package within a specified temperature range for a pre-defined period of
transport, without reliance on mechanical assistance. The packages are hermetically
sealed in specific configurations and do not rely on any further human or mechanical
intervention to perform to a specific level during transport. However, they have a
predefined transport life and consequently delivery must always be achieved within this
period5. Figure 1 shows an example of both a reusable and a single-use passive container.
Figure 1 Generic passive containers with coolant packs

Reusable container

Disposable insulated carton

The impact-resistant outer layer of disposable packaging is made of corrugated fibreboard

which protects the insulated lining. Reusable containers have a durable plastic outer shell,
insulating core and inner liner designed to last for multiple journeys. In both cases,
thermal control is provided by coolants which are chosen to maintain a specific
temperature range inside the package; depending on the type of container these may
ODonnell, K., Wright, A. Good Distribution Practices by Air, Road & Ocean Workbook and Resource
Guide, 2013.

Technical Supplement: Temperature-controlled transport operations

11

either be disposable or reusable. The packaging system is completed by other ancillary

packaging components used as separators, dividers or dunnage.
The temperature of the product within the package is maintained by applying the physics
of conduction and convection in conjunction with the stored latent heat of fusion from the
refrigerant. All passive packaging systems contain a finite amount of refrigerant energy.
More sophisticated packaging uses advanced phase change materials (PCMs) instead of
water-based gel packs or simple water-packs.
2.2.4

Active shipping systems for air transport

The typical active shipping system is a dedicated portable container. They come in two
types: systems with cooling only, and systems with both heating and cooling. The
temperature stabilizing medium in active shipping systems typically comprise dry ice
(cooling types only) or use phase change materials (heating and cooling types) as a means
to provide temperature control, although compressor-driven cooling systems are also
used. These containers are either powered by on-board batteries, or use an external
electrical source to run on-board compressors or heat pumps. Thermostatic control is
used to activate the cooling or heating mechanism and circulating fans help to maintain
temperature within specified limits around the enclosed product. Larger containers are
generally leased from the manufacturer, or by an air or ocean carrier, or by a third party
logistics service provider. Figure 2 shows an example.
Figure 2 Active air transport container type LD3

2.2.5

Active shipping systems for ocean transport

High performance ocean containers, specifically designed for transport of TTSPPs have
recently been developed6. These use a refrigeration and air circulation system running off
the ships on-board power supply, and incorporate integrated satellite tracking. Current
availability of these containers is very limited. Similarly, the availability of oldergeneration refrigerated containers is often scarce, transport times are lengthy, the risk of
mechanical failure is high, and close logistics monitoring is necessary for transport to and
from ports. The refrigeration systems of all ocean containers require an external power
source either electricity or an integrated gas powered generator. As with air cargo, the

See: http://www.blueyellc.com/download/Blueye_Sea_Container.pdf

Technical Supplement: Temperature-controlled transport operations

12

greatest risk is temperature exposure in port before loading and unloading. Unfortunately,
this time is often measured in days, not hours. Historically, the pharmaceutical industry
has shied away from the ocean transport option because of concerns over long transport
times, environmental exposure at sea such as temperature and humidity, loss at sea, and
port security concerns. In addition, most shipping lines refuse such shipments because of
the high liability involved. For all these reason, the operational management of these
systems is not discussed further.

2.3

Defining user requirements

A safe and reliable temperature-controlled transport operation starts with a

comprehensive User Requirements Specification. This can be used as a basis for
contracting out services via a Service Level Agreement, or for managing an in-house
operation. However, the service is provided, suitable SOPs, standard check lists and
associated work instructions must be developed and used to control each shipment.
2.3.1

User Requirements Specification

The shipper is responsible for ensuring that the packaging and the mode(s) of transport
used to distribute TTSPPs are capable of maintaining the products within their specified
temperature and humidity ranges. Accordingly, the detailed requirements for each type of
transport operation must be fully defined and suitable transport service providers
identified and appointed. The correct way to do this is to draw up a User Requirements
Specification (URS). This document should clearly define the following:

The temperature and humidity parameters that must be maintained for each
product or product type; these parameters are determined by the product label, or
when acceptable, the manufacturers stability data;

The transport mode and/or vehicles to be used;

The required level of service;

Acceptable levels of risk to product and performance;

The types of packaging;

The types of temperature and humidity monitoring devices to be employed and

the acceptable level of accuracy of these devices;

Specific service actions such as go/no-go decision-making in the event of a

temperature excursion event, or more complex analytical data gathering and
reporting requirements.

The URS can be used as a basis for developing SOPs and work instructions for in-house
transport operations, and/or a Service Level Agreement for contracted-out transport
services.
2.3.2

Service Level Agreements (SLAs)

Shippers and other transport service provider stakeholders should operate under the
terms of an SLA, which specifies the target and minimum levels of performance, service,
operation or other attributes as set out in the URS. In-house transport services should be
controlled with a similar level of rigour. An SLA should contain the following elements:
Introduction:

Technical Supplement: Temperature-controlled transport operations

13

Purpose and objective of the SLA;

Parties to the agreement;

Commencement date;

Duration of the agreement;

Definitions and glossary of terms.

Scope of work:

Standard service(s);

Non-standard service(s);

Place of service, including collection and delivery locations;

Changes to service.

Compensation:

Fee tariff;

Invoicing arrangements;

Payment terms.

Performance monitoring and reporting:

Managing changes in key personnel;

Service benchmarks;

Service monitoring and reporting mechanisms;

Service review meetings.

Problem management:

Support services;

Problem identification;

Problem escalation procedures.

Duties and responsibilities:

Customer / client personnel, facilities, resources;

Training for specialized equipment/tasks;

Approvals.

Warrantees and remedial action:

Allocation of responsibilities between the parties to the agreement;

Liability;

Resolution procedures and penalties for non-compliance.

2.4

Identifying and controlling risk

A key characteristic of transport operations is the number of touch-points, hand-offs or

process and service exchanges between the various organizations and individuals
involved. The TTSPP product is at the greatest risk of improper handling during these
exchanges. For this reason they are defined as Critical Control Points in the transport
supply chain. Table 1 lists the actions that need to be taken to reduce risk or hazard to an
acceptable level at each of these key stages.
Technical Supplement: Temperature-controlled transport operations

14

Technical Supplement: Temperature-controlled transport operations

15

Table 1 Critical Control Point actions

Critical handling process

Type of control

Product preparation and

conditioning at shippers location

Electronic temperature and humidity monitoring of

storage facility. i.e. refrigerator, freezer, cold room,
warehouse

Defined conditioning specifications for packaging

components temperature and duration

Product loading at shippers

location

Defined process, check sheet

Defined actions in the event of delays

Ground transport from shipper

location

Use of refrigerated or temperature-controlled vehicle

Temperature defined and pre-conditioned before
loading.
Electronic temperature/humidity monitoring

Warehousing (en route)

Airport tarmac/apron

Aircraft hold

Serviceability checks on equipment

Defined actions in the event of delays

Temperature/humidity monitoring

Availability of batteries, electrical connections or dry ice

to maintain correct temperature of active containers

Availability of sub-zero, refrigerated or controlled room

temperature storage when required

Defined storage instructions

Defined actions in the event of delays, and mishaps en

route

Minimize time exposed to ambient temperatures

High priority ramp handling

Covered storage when transiting through multiple

airports

Defined actions in the event of delays

Avoid positioning near cargo door

Cargo hold temperatures maintained between +15C and

+25C

NOTOC (notice to captain) defining cargo hold

temperature setting or use of dry ice in active containers

The following sub-sections set out the content of the checklists needed to operate three
distinct types of shipping system:

refrigerated and temperature-controlled vehicles;

passive shipping systems sent by road and air transport

operations using both passive and active containers.

Each of the checklists follows the same sequence: pre-shipment actions; actions on the day
of shipment at the point of origin; actions during transit; actions on the arrival day at the
destination and, finally, post-shipment actions.

Technical Supplement: Temperature-controlled transport operations

16

2.5

Managing refrigerated road shipments

Refrigerated and temperature-controlled transport services are often supplied by a third

party service provider specializing in such transport. Alternatively, the service may be
directly operated by a national public health system, a parastatal company, or by a publicprivate partnership (PPP). In all cases it is important that service providers conduct
regular, periodic training of responsible personnel, whether directly employed or subcontracted.
It is essential that the correct infrastructure is in place to support the operation of these
specialized vehicles. Specifically, all regular drop-off points should have a compatible
electrical connection to power the cooling unit especially for smaller vehicles where the
refrigeration circuit is powered off the vehicle engine generator. Otherwise the vehicle
engine has to remain running. This is critically important in settings that involve
overnight stops.
Vehicles should be equipped with an integrated continuous temperature monitoring and
data logging system. In addition retrievable temperature data logging devices should
preferably also be packed with the shipped product7.
The action sequence below should be followed.
Pre-shipment actions:
a. Arrange booking, pick-up time and location.
b. Obtain confirmation from the consignee to ship the product (e.g. purchase order or
requisition).
c. Verify product dimensions and determine the type of container required.
d. Book the shipment with the freight forwarder or transport service provider.
e. Specify temperature requirements.
f.

Prepare shipping documentation and checklists.

g. Ensure that the designated vehicle is in good working order, that its service record
is up-to-date and that the driver has carried out the relevant daily safety
inspection.
Shipping day: actions at point of origin:
a. Confirm booking, pick-up time and location.
b. Pack the product in its correct tertiary package and attach temperature monitoring
devices to suit the routing requirements. Keep product under proper storage
conditions until the time of despatch.
c. Before loading, pre-condition the product and the refrigerated vehicles cargo area
of the to the same transport temperature.
d. Ensure that the thermostatic controller on the transport vehicle is set to the
required temperature and ensure that the temperature recording device(s) are
operating properly.

For details of suitable systems refer to Technical Supplement: Temperature and humidity
monitoring systems for transport operations.

Technical Supplement: Temperature-controlled transport operations

17

a. Check that vehicles refrigeration unit is operating properly and that the
temperature has stabilized. Keep loading door(s) closed until it is time to load the
product. Drivers must ensure the correct temperature setting has been selected.
e. Load product without delay. Do not overload the vehicle. Allow for air circulation
around all sides of the product. Properly block and brace the load, as shown in
Annex 1, to avoid shifting during transit. Close door(s) and apply security seal
and/or lock if required.
f.

If the refrigeration unit has been operating on mains electric power during loading,
make sure that engine-powered refrigeration system is operating correctly and
that the temperature has stabilized within pre-defined limits before releasing.

g. Provide clear instructions to the driver covering the correct load temperature,
handling and transport requirements.
h. Provide emergency contact information to the driver.
i.

Ensure that all paperwork and checklists are completed by responsible parties.

Actions during transit:

a. Cooling units must remain active throughout the entire journey, including stops
and rest periods.
b. Energy-saving modes/options of the cooling unit should not be used.
c. Vehicle payload doors must only be opened during loading and unloading and
opening time must be kept to a minimum.
Arrival day: actions at destination point(s):
a. Ensure priority unloading.
b. Remove product from the vehicle and move it immediately to correct temperaturecontrolled storage conditions.
c. Retrieve temperature data from driver. Refer to the companion Technical
Supplement: Temperature and humidity monitoring systems for transport
operations.
d. Record temperature upon arrival. Communicate any deviations to the appropriate
personnel.
e. When the product is received, the consignee should retrieve and deactivate the
temperature monitors accompanying the shipment and read and download the
data. Note: If temperature monitors are not packed with the product, the data from
the on-board temperature recording system should be downloaded, or a print-out
obtained from the driver and attached to the arrival forms.
f.

Ensure all checklists and arrival forms are completed by the responsible parties.

Post shipment actions:

Forward completed checklists and completed arrival forms to appropriate personnel,
including electronic temperature data files.

2.6

Managing passive container road shipments

Covered vehicles should be used for transporting passive containers so that shipments are
not exposed to the sun or to the elements. The action sequence below should be followed.

Technical Supplement: Temperature-controlled transport operations

18

Pre-shipment actions:
a. Ensure that there are sufficient quantities of all packaging components to
accommodate the shipment on the shipping day.
b. Ensure that all components have been conditioned to the correct temperature (i.e.
temperature stabilizing media, whether frozen or refrigerated).
c. Ensure that the designated vehicle is in good working order, that its service record
is up-to-date and that the driver has carried out the relevant daily safety
inspection.
Shipping day: actions at point of origin:
a. Prepare and pack product in its designated secondary or ancillary packaging. If
possible, keep product under correct storage conditions until it is placed in the
container.
b. Assemble the passive shipping system in accordance with the manufacturers
instructions.
c. Load the product without delay. Do not overload containers.
d. Add temperature data loggers or temperature indicators if required. Place in close
proximity to the product. Do not allow them to come in contact with temperature
stabilizing media.
e. Add dunnage if necessary to prevent the product from shifting during transit.
f.

Ensure that all paperwork and checklists are completed by the responsible parties.

Actions during transit:

a. Vehicles must be parked in the shade during rest stops and the like;
b. Containers must not be opened during transit.
Arrival day: actions at destination:
a. Open packaging, remove product from its passive shipping system and move it
immediately to correct temperature-controlled storage conditions.
b. Retrieve and deactivate temperature monitors for data retrieval.
c. Ensure all checklists and arrival forms are completed by responsible parties.
Post shipment actions:
a. Forward completed checklists to appropriate personnel, including electronic
temperature data files.
b. Process packaging by disposal, reconditioning or reuse as appropriate.

2.7

Introduction to air transport

Because of time considerations, lack of infrastructure, and geographical obstacles, air

transport is frequently the mode of choice for long distance transport for TTSPPs, both
between and within countries. The International Air Transport Associations Perishable

Technical Supplement: Temperature-controlled transport operations

19

Cargo Regulations Chapter 17 is the industrys framework for meeting Good Distribution
Practices (GDP)8. The purpose of the regulations is to:

Describe packaging/systems used in drug product distribution;

Identify potential risks to product quality;

Recommend Critical Control Points to reduce these risks;

Describe operating agreements such as SLAs or Quality Agreements;

Define and delineate Quality Management System requirements;

Define labelling requirements.

Many air carriers offer branded services with defined procedures based on GDP to meet
the specific needs of TTSPPs. Any variation or deviation from such a branded service
should be defined and negotiated beforehand in a specific SOP.
In order to minimize risk, shippers should always collaborate with the air carrier, either
directly or through the designated freight forwarding agent. It is essential to do this in
order to define and agree the service level needed to meet the shippers requirements.
Temperature control within the cargo holds of most aircraft is limited and wide variations
can occur throughout the hold; these variations depend upon placement, location, time at
altitude, and the duration of the flight. However, the greatest and most frequent
vulnerability to temperature exposure occurs on the airport tarmac when goods are
exposed to the elements before aircraft loading, or during unloading. Every precaution
should be made to limit this exposure. Shippers are encouraged to work with their air
service suppliers to minimize tarmac times.
2.7.1

Types of air carrier

Four different business models are used for the transport of TTSPPs by air: legacy carriers;
integrators; cargo only carriers, and charters. Within each category, carriers will have
different service offerings and service levels tailored to the handling requirements of
specific cargo.

Commercial airlines: These companies operate both passenger and cargo services
and have the advantage that they service a wide range of destinations. Most of
these carriers subcontract services for aircraft handling, ground handling and
warehousing operations. A commercial airlines cargo business usually comes from
freight forwarders and the airline involvement is limited to airport-to-airport
activities. Some may offer road feeder services at origin or destination. Otherwise,
a freight forwarding agent coordinates that effort.

Integrators: These operate large scale door-to-door mail and express delivery
services. Their product offerings are integrated under a single brand identity (i.e.
FedEx, DHL and UPS). They generally deal directly with the shipper rather than a
freight forwarder.

Cargo only carriers: These companies do not carry passengers; they operate
dedicated freighter aircraft and can carry large cargo payloads. Network s are not

8 GDP requirements embrace the activities of phamaceutical manufacturers, shippers, 3PLs, 4PLs,
cargo agents, freight forwarders, independent air carriers, airlines, packagers and active solution
platform providers, warehousing agents and ground handlers.

Technical Supplement: Temperature-controlled transport operations

20

as extensive as the commercial airlines, which operate on a hub and spoke model.
Cargo only carriers often sign contracts with large, international freight
forwarders to ensure cargo space availability. Their services may include ground
pick-up and delivery. As with commercial airlines, their ground handling
operations are often subcontracted.

2.7.2

Charters: These operators allow shippers to choose between a full or partial

charter. Freight forwarders with a need for dedicated space on certain highvolume trade lanes often employ charters.
Air transport labelling

Since July 2012, the IATA Time and Temperature Sensitive label, shown in Figure 3, has
been mandatory for the transport of healthcare cargo shipments. There are however,
specific conditions for proper use of the label. These can be found in the current edition of
the IATA Perishable Cargo Regulations, Chapter 17: Logistics for Temperature Sensitive
Healthcare Products.
Figure 3 Example of IATA Time and Temperature Sensitive label

Keep between +15C to +25C

Actual size 10cm x 10 cm

The principal rules for the correct use of the label are as follows:

Shipments must be booked under the proper handling code and as temperaturecontrolled healthcare cargo in accordance with the IATA Perishable Cargo
Regulations

The label must be used for healthcare products only.

The label may be applied to both active and passive shipping systems.

The lower half of the label must indicate the external handling temperature range
or limit (minimum and maximum) that the package can be exposed to during
transport.

The label is attached to a consignment which has been specifically booked as a

time and temperature-sensitive healthcare product9.

The temperature range on the label must match the temperature range or limit
stated on the AWB, SLA and/or SOP.

The text must be in English and temperatures must be shown in degrees Celsius.

This is a premium service beyond that offered for general cargo.

Technical Supplement: Temperature-controlled transport operations

21

The label must be applied by the shipper or by his designated agent.

Only one label is required. This must be visible on the outermost means of
containment (box, over-pack, or ULD).

2.8

Air transport processes

Air transport operations must be tightly managed. In addition to the tasks that must be
carried out to ensure the safe arrival of a specific shipment see Section 2.9 there are a
number of higher level precursor and recurrent actions that need to be taken. These are
described below.
The shipper should:

Conduct regular periodic training of personnel;

Maintain an SLA with the appropriate stakeholders and transport service

providers;

Qualify the transport process to the extent possible.

The freight forwarder should:

Conduct regular periodic training for directly employed and sub-contracted

personnel;

Maintain a quality management system that meets the shippers requirements;

Maintain SLAs with subcontractors.

The air carrier and ground handlers should:

Conduct regular periodic training of directly employed and sub-contracted

personnel.

The consignee should:

2.9

Conduct regular periodic training of personnel.

Managing air shipments

The actions described below apply to both active and passive shipping systems, unless
specifically identified.
Pre-shipment actions:
a. Obtain confirmation from the consignee to ship the product (e.g. purchase order or
requisition).
b. Verify product dimensions and determine the type of container required.
c. Notify the freight forwarder of the shipping date and book the shipment. The
freight forwarder must coordinate the transport chain and booking with the air
carrier;
d. Communicate instructions to the freight forwarder regarding pick-up, transport
and handling requirements, including transport temperature requirements.
e. Prepare shipping documentation, including checklists and air waybill (AWB) and
review with the freight forwarder.
f.

Arrange ground transport to airport at point or origin.

Technical Supplement: Temperature-controlled transport operations

22

Shipping day: actions at point of origin:

a. Condition and pack the product and place activated temperature monitors within
the load.
b. Label the product box to indicate the temperature range in which the shipment
must be handled (see IATA PCR Chapter 17.10 for details).
c. Transport product to the freight forwarder in a temperature controlled truck or
refrigerated vehicle. The freight forwarder must obtain the shippers approval
before implementing any changes that could affect GDP or the quality of the
shipped product.
Shipping day: actions at departure airport by freight forwarder:
The following action sequence assumes that the freight forwarder loads the ULD:
a. Active dry-ice systems only: Load the amount of dry ice recommended by device
manufacturer into the dry ice bunker. Install fresh D Cell batteries.
b. Active systems: Set the thermostatic controller to the desired temperature. Ensure
that the container is operating properly and wait until the temperature stabilizes.
c. Load product into container. Ensure correct build-up of the ULD and labelling in
accordance with written instructions. Do not overload. Allow for air circulation
completely around product, including the bottom. Strap the load to the floor or
wall stanchions to avoid shifting during transit.
d. Close door(s). Apply security seal/lock.
e. Activate and position any exterior (ambient) temperature monitors.
f.

Secure paperwork in the external clear-view envelope.

g. Before releasing the container to the airline, ensure that it is operating correctly
and that the temperature has stabilised.
h. Transport to the airline and hand off. From this point onward the airline is
responsible for maintaining the appropriate ambient temperature during storage
and flight, for checking power and for re-icing the container if required, in
accordance with the relevant SOP.
i.

Ensure priority handling onto the aircraft.

j.

Ensure all checklists are completed by responsible parties in accordance with the
SOP.

k. Forward the AWB and other paperwork/instructions to the appropriate personnel.

l.

Maintain tracking and traceability of the product throughout the transport

process.

m. Promptly resolve and communicate any deviations.

n. Perform customs brokerage.
Shipping day: actions at by air carrier and ground handlers:
a. Review the AWB and other shipping documentation with the freight forwarder
and ensure that is compliant with carrier and country regulations and procedures.
b. Comply with the programmed flight schedule and ensure that adequate cargo hold
space is available.

Technical Supplement: Temperature-controlled transport operations

23

c. Communicate any delays or problems to the freight forwarder.

d. Update any temperature monitor log sheets.
e. Store the product in conditions that are within the defined temperature range on
the label and AWB.
f.

Minimize the elapsed time between warehouse and aircraft loading/unloading

(tarmac time).

g. Handle active and passive shipping systems in accordance with shippers

instructions.
h. Load the consignment in the aircraft. Wherever possible, avoid placing
temperature-sensitive freight near the aircraft cargo door.
i.

Maintain recommended cargo hold temperature settings.

j.

Transport the product from the departure airport to the destination airport.

k. Store the product at transit airports in an area kept within the specified handling
temperature range.
l.

Inform the freight forwarder of arrival.

Arrival day: actions at destination:

a. Ensure priority unloading from the aircraft.
b. Handle active and passive shipping systems in accordance with shippers
instructions.
c. Store the product at the arrival airport in an area kept within the specified
handling temperature range.
d. Active systems: Check that container is operating properly. Re-ice and replace
batteries if required.
e. Active systems: Record the temperature as shown on the outside display panel.
f.

Freight forwarder assists with customs clearance and logs receipt of the product
from the service provider.

g. Provide clear instructions for either unloading the container at the airport or for
transporting to the consignee.
h. Inspect goods for physical damage and evidence of temperature abuse.
i.

Ensure all checklists are completed by responsible parties.

j.

Consignee receives product, retrieves and deactivates EDLMs for data retrieval, if
applicable.

Post shipment actions:

a. Forward completed checklists to appropriate personnel, including the electronic
temperature data files.
b. Transport the empty container to the ground handler, check for damage and
functionality.
c. Return any packaging and/or temperature monitoring devices, if applicable.
d. Forwarder collects all pertinent data, checklists, etc., to complete shipment.

Technical Supplement: Temperature-controlled transport operations

24

A similar international shipping procedure has been developed by UNICEF Supply Division
specifically for shipping vaccines in passive containers. This process, together with the
UNICEF Vaccine Arrival Report form, is described in EVM-SOP-E1-02: Vaccine arrival
procedures.

Technical Supplement: Temperature-controlled transport operations

25

References

EVM-SOP-E1-02: Vaccine arrival procedures. WHO. Effective date: October 2011.

IATA. Chapter 17 Air transport logistics for time and temperature-sensitive

healthcare products. 9th Edition, June 2013.

IATA. Temperature Control Regulations: The Global Standard for the Safe
Transportation of Healthcare Products by Air.
https://www.iata.org/publications/Pages/temperature-control-regulations.aspx

Management Sciences for Health. MDS-3: Managing Access to Medicines and other
Health Technologies. 3rd Edition. Kumarian Press, 2011. Available free on-line at:
http://www.msh.org/resources/mds-3-managing-access-to-medicines-andhealth-technologies

ODonnell, K., Wright, A. Good Distribution Practices by Air, Road & Ocean
Workbook and Resource Guide, Excelsius Cold Chain Management, 2013.

WHO Technical Supplement. Qualification of shipping containers.

WHO Technical Supplement. Qualification of temperature-controlled road vehicles.

WHO Technical Supplement. Temperature and humidity monitoring systems for

transport operations.

WHO Technical Supplement. Transport route profiling qualification.

Technical Supplement: Temperature-controlled transport operations

26

Annex 1 Packing a refrigerated vehicle

The following diagrams show the correct procedure for packing a refrigerated or
temperature-controlled vehicle.

Technical Supplement: Temperature-controlled transport operations

27

Revision history
Date

Change summary

Reason for change

Technical Supplement: Temperature-controlled transport operations

Approved

28